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The Sentinel Effect:

The Sentinel Effect: The theory that productivity and outcomes can be improved through the process of observation and measurement. Based on the now-controversial 'Hawthorne study' of the 1930's.

Richard Eskow is CEO of Health Knowledge Systems (HKS) in Los Angeles, which provides services to the healthcare and workers’ compensation industries. Through Eskow and Associates, Richard is also a consultant specializing in healthcare and insurance, IT, strategic planning, and communications. Most clients are in the IT and health-related industries, although Richard has also worked with NGO’s, state and national governments, and in the entertainment industry.

Richard had senior executive positions at several Forture 500 firms and was CEO of two medical management companies before forming HKS. He also served as a senior consultant to the World Bank, the U.S. State Dept/USAID, and government and private entities in over 20 foreign countries. Areas of expertise included health policy, healthcare investment, operations, marketing, and strategic planning.

Debating the Science of Dead Pop Stars

September 19, 2007

If there’s a rock and roll heaven, sang the Righteous Brothers, you know they’ve got a hell of a band. Maybe — but the real question is, do they have a health plan? According to one study, “famous” pop stars are far more likely to die prematurely than the general population — often from either drug use or depression. That finding is objectionable to some rock fans, but their protests raise a different set of problems. Numbers can be misused or twisted, but they hold wisdom. In this case, they may have more to teach us than even the study’s authors realize.

The authors give this reason for conducting the study: “While qualitative reviews support rock and pop stars suffering high levels of stress depression, and substance use, quantitative studies of mortality amongst such individuals are almost completely absent.” The piece goes on to describe their methodology in detail, and it looks reasonable.

Their findings are interesting, although they may seem obvious (or, as analysts prefer to say, “intuitive.”). American and European pop stars (including rock, rap, and R&B) are more likely to die young than their peers, when compared to populations with similar backgrounds. The authors use valid sample sizes, and their results are statistically significant.

Statistical validity is important, whether we’re discussing dead pop stars, cancer victims, or the frequency and size of hurricanes. Any one event — a death, a storm, an accident — can be caused by many things. But when the numbers reveal a pattern, there is an underlying story to be told.

Ideologues and industry spokespeople often challenge the idea of statistical significance, using the general public’s innumeracy to cast doubt on everything from global warming to carcinogens in the environment. But the “Elvis to Eminem” study brought objections from a different quarter. Music blogger Brad Laidman wrote a critical post called “I Want My Rock Stars Dead.” It was then distributed to the email list for Rock and Rap Confidential, Dave Marsh’s music magazine.

What were their objections to the study? First, Laidman goes after the methodology with a classic anti-science line of attack: “Their study sample is too small and 75 percent of it hasn’t managed to die yet.” That’s wrong, and here’s a simple response: Even if all of a sample group hasn’t died yet, some percentage of it has. If that percentage is greater than it is for the general population, in a statistically meaningful way, then something significant is taking place.

What are Laidman’s other objections? “My guess is all artists have increased incidence of substance abuse, not just Rock Stars — but no one is paying me to study this.” His observation may or may not be true, but it doesn’t invalidate the findings of this study. Instead, it suggests another one might also be worthwhile. (I suspect he’s right.)

“The drummer from Boston (the group) is not a Rock Star,” Laidman continues, “no matter how long he does or does not live.” Aesthetically and artistically, that may be true. But if he got a piece of the band’s royalties he lived like one, and lifestyle health factors are the topic of this study. He continues:

“Kurt Cobain…didn’t technically die from his heroin use…so (quoting from the study) ‘Collaborations between health and music industries (that) focus on improving both pop star health and their image as role models to wider populations’ would have done little to prevent the following deaths. In fact, perhaps the proper inference would be to avoid touring and to stay away from guns.”

A list of murders and travel-related deaths then follows.

There are at least two problems with that paragraph. First, it ignores the following section of the study: “Consistent with other studies of pop stars, a disproportionate amount of their mortality appears to be related to alcohol and drug use.” In other words, the authors studied that very issue and found that, in fact, drugs and alcohol did account for a large number of those early deaths.

Regarding Cobain, who “didn’t technically die” from his addiction, there is a strong and well-established correlation between drug and alcohol abuse and suicide. Drugs and alcohol lower inhibitions, making it easier for people to act out on their suicidal emotions.

Here’s another point: Contrary to the romantic notions of some, the subjective experience of abusing drugs and/or alcohol is often an unpleasant one. How many of us would voluntarily switch places with Amy Winehouse as she carves her chest with broken glass?

“Any study that can’t explain why Brian Wilson is alive while Carl Wilson is dead,” write Laidman, “just opens up a huge unanswerable can of worms.” But that’s not true. The Wilson family can only provide anecdotal information, while scientific studies can identify trends.

I’m not sure why Laidman and Rock and Rap dislike the study. Maybe I’m missing something, but a world where musicians are treated for their stress and addiction problems rather than exploited and then discarded, sounds like a better world to me.

My biggest problem with Laidman’s innumeracy and Rock and Rap’s endorsement of his piece is this: He attacks scientific methodology in order to make a point. In the long run, that hurts more good causes than bad ones. If they don’t like the study’s conclusions, they need to challenge it on more meaningful grounds, or use the study’s data differently.

Here’s a good place to start: The study’s authors note that 25 years after becoming “famous” the mortality of European rock stars becomes that of the general population’s, while North Americans remain at much greater risk. In fact, they write that “North American pop stars appear more susceptible to chronic conditions.” What might account for that difference?

Here’s a possibility the authors don’t raise: Aging European pop stars have national health coverage, while U.S.-based North Americans don’t. Many well-known musicians here have surprisingly low incomes and struggle to pay their medical bills. That’s a fact that Dave Marsh knows well, having been active in raising funds to assist older musicians. Rather than dismissing this study, he and others should look at it carefully and use it to help musicians — and other Americans — get the health coverage they need to live healthy, productive lives.

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